Abstract
With the expected rise in the geriatric patient population, delivery of healthcare for elderly patients will require more resources in the next several decades. The development of cancer is more common in the geriatric population since two-thirds of cancers are typically discovered in the elderly. The elderly often have associated medical comorbidities. Treatment of the geriatric patient population will encompass more personalized approaches based on their functional status. Surgical management of elderly cancer patients is complex. Not only does it require incorporation of multimodality care, the treating physician needs to balance risks and benefits from options available due to patient medical comorbidities leading to posttreatment debilitation and side effect profiles. Furthermore, there are also insufficient studies in the elderly population in terms of long-term oncologic follow-up as many studies frequently exclude the elderly in their study designs. With the development of newer modalities of treatment such as ablative procedures, minimally invasive approaches, and immunotherapy, the selection of treatment methods will need to balance optimal oncologic outcome with expected patient survival.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
National Cancer Institute. Cancer prevalence and cost of care projections external. Accessed 30 May 2019.
Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975–2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.
Soto-Perez-de-Celis E, Li D, Yuan Y, et al. Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol. 2018;19:e305–16. https://doi.org/10.1016/S1470-2045(18)30348-6.
Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the ‘Silver Tsunami’: prevalence trajectories and co-morbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25:1029–36. https://doi.org/10.1158/1055-9965.
Bentrem DJ, Cohen ME, Hynes DM, et al. Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch Surg. 2009;144:1013–20.
Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271–89.
Mariotto AB, Wang Z, Klabunde C, et al. Life tables adjusted for comorbidity more accurately estimate noncancer survival for recently diagnosed cancer patients. J Clin Epidemiol. 2013;66:1376–85. https://doi.org/10.1016/j.jclinepi.2013.07.002.
Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117–28. https://doi.org/10.1093/jnci/djq495.
Yeo HL, O’Mahoney PRA, Lachs M, et al. Surgical oncology outcomes in the aging US population. J Surg Res. 2016;205:11–8.
Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high risk cancer operation: a national study. J Am Coll Surg. 2007;205(6):729–34.
Al-Refaie WB, Parsons HM, Henderson WG, et al. Major cancer surgery in the elderly: results from the American College of Surgeons national surgical quality improvement program. Ann Surg. 2010;251:311–8.
Van Gestel YR, Lemmens VE, de Hingh IH, et al. Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients. Ann Surg Oncol. 2013;20:371–80.
Neri S, Gardini A, Facchini A, et al. Mismatch repair system and aging: microsatellite instability in peripheral blood cells from differently aged participants. J Gerontol. 2005;60:285–92. https://doi.org/10.1093/gerona/60.3.285.
Loh KP, Soto-Perez-de-Celis E, Hsu T, et al. What every oncologist should know about geriatric assessment for older patients with cancer: Young International Society of Geriatric Oncology position paper. J Oncol Pract. 2018;14:85–94. https://doi.org/10.1200/JOP.2017.026435.
Fagard K, Leonard S, Deschodt M, et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: a systematic review. J Geriat Oncol. 2016;7:479–91.
Ghignone F, van Leeuwen BL, Montroni I, et al. The assessment and management of older cancer patients: a SIOG surgical task force survey on surgeons’ attitudes. EJSO. 2016;42:297–302.
Janssen-Heijnen ML, Maas HA, Houterman S. Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer. 2007;43:2179–93.
Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.
Hamel MB, Hendrson WG, Khuri SF, et al. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.
Gajdos C, Kile D, Hawn MT, et al. Advancing age and 30-day adverse outcomes after nonemergent general surgeries. J Am Geriatr. 2013;61:1608–14.
Maekawa Y, Sugimoto K, Yamasaki M, et al. Comprehensive geriatric assessment is a useful predictive tool for postoperative delirium after gastrointestinal surgery in old-old adults. Geriatr Gerontol Int. 2016;16:1036–42. https://doi.org/10.1111/ggi.12587.
Griebling TL. Re: geriatric assessment in surgical oncology: a systematic review. J Urol. 2016;195:1079–80. https://doi.org/10.1016/j.juro.2015.12.060.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Velanovich V, Antoine H, Swartz A, et al. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183:103–10.
Dripps RD. New classification of physical status. Anesthesiology. 1963;24:111.
Scott S, Lund JN, Gold S, et al. An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting. BMC Anesthesiol. 2014;14:104. https://doi.org/10.1186/1471-2253-14-104.
Ceccarelli G, Andolfi E, Biancafarina A, et al. Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review. Aging Clin Exp Res. 2017;29:55–63. https://doi.org/10.1007/s40520-016-0676-5.
Weber DM. Laparoscopic surgery – an excellent approach in elderly patients. Arch Surg. 2003;138:1083–8.
Caglia P, Tracia A, Buffone A, et al. Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg. 2016;33:S97–S102.
Amelung FJ, Borstlap WAA, Consten ECJ, et al. Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg. 2019; https://doi.org/10.1002/bjs.11172.
Chesney T, Acuna SA. Do elderly patients have the most to gain from laparoscopic surgery? Ann Med Surg. 2015;4:321–3.
Bellio G, Troian M, Pasquali A, et al. Outcomes of laparoscopic surgery for pT3/pT4 colorectal cancer in young vs. old patients. Minerva Chir. 2019; https://doi.org/10.23736/S0026-4733.19.07895-7.
Giuliani A, Ceccarelli G, Rocca A, et al. The role of laparoscopic distal pancreatectomy in elderly patients. Minerva Chir. 2018;73:179–87. https://doi.org/10.23736/S0026-4733.18.07594-6.
Ciria R, Gomez-Luque I, Ocana S, et al. A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for hepatocellular carcinoma: updated results from the European guidelines meeting on laparoscopic liver surgery, Southampton, UK, 2017. Ann Surg Oncol. 2017;26:252–63. https://doi.org/10.1245/s10434-018-6926-3.
Chen K, Pan Y, Maher H, et al. Laparoscopic hepatectomy for elderly patients – major findings based on a systematic review and meta-analysis. Medicine. 2018;97(30):1–12. https://doi.org/10.1097/MD.000000000011703.
Bandoh T, Isoyama T, Toyoshima H. Total gastrectomy for gastric cancer in the elderly. Surgery. 1991;109(2):136–42.
Bourcier K, Dinart D, Le Cesne A, et al. Outcome of patients with soft-tissue sarcomas: an age-specific conditional survival analysis. Oncologist. 2019;24(7):3559–e564.
Fong Y, Blumgart LH, Forner JG, et al. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg. 1995;222:426–37.
Poon RT, Law SY, Chu KM, et al. Esophagectomy for carcinoma of the esophagus in the elderly: results of current surgical management. Ann Surg. 1998;227:357–64.
Ellis FH Jr, Williamson WA, Heatley GJ. Cancer of the esophagus and cardia: does age influence treatment selection and surgical outcomes? J Am Coll Surg. 1998;187:345–51.
Frakes JM, Strom T, Springett GM, et al. Resected pancreatic cancer outcomes in the elderly. J Geriatr Oncol. 2015;6:127–32.
Kishida N, Hibi T, Itano O, et al. Validation of hepatectomy for elderly patients with hepatocellular carcinoma. Ann Surg Oncol. 2015;22:3094–101.
Makary MA, Winter JM, Cameron JL, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56.
Daher M. Ethical issues in the geriatric patient with advanced cancer ‘living to the end’. Ann Oncol. 2013;23:vii55–vii58. Supplement 7.
Willmott L, White B, Gallois C, et al. Reasons doctors provide futile treatment at the end of life: a qualitative study. J Med Ethics. 2016;42:496–503.
Chiabi P, Magne N, Breton S, et al. Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients. Crit Rev Oncol/Hem. 2011;79:302–7.
Terret C, Zulian G, Droz JP. Statements on the interdependence between the oncologist and the geriatrician in geriatric oncology. Crit Rev Oncol/Hem. 2004;52:127–33.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Da Dong, X., Barasch, S. (2020). Operative Surgical Oncology in the Elderly: Epidemiology, Opportunity, Outcome, and Ethical Issues. In: Latifi, R. (eds) Surgical Decision Making in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-47963-3_20
Download citation
DOI: https://doi.org/10.1007/978-3-030-47963-3_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-47962-6
Online ISBN: 978-3-030-47963-3
eBook Packages: MedicineMedicine (R0)